Mikhail Michael, Sallam Ahmed
Royal Victoria Hospital, Belfast, UK.
Gloucestershire Hospitals NHS Foundation Trust, UK.
Med Hypothesis Discov Innov Ophthalmol. 2013 Winter;2(4):113-20.
This article reviews the new clinically relevant data regarding the intraocular treatment of non-infectious uveitis. Triamcinolone acetonide is the most commonly used intravitreal corticosteroid for treatment of uveitis and uveitic macular oedema. The drug is available at low cost but it is associated with a high risk of raised intraocular pressure (IOP) and cataract and is not licensed for intraocular use. Dexamethasone implant (Ozurdex®) appears to have a better safety profile, and a slightly long-lasting effect than triamcinolone acetonide. Fluocinolone acetonide implant (Retisert®) implant allows the release of corticosteroids at a constant rate over a 3-year period, but it requires surgical placement and its use is associated with a very high risk of cataracts and raised intraocular pressure. Iluvien® is another fluocinolone acetonide implant that could represent a more convenient treatment option for such cases in the future as it can be inserted into the vitreous cavity through 25-gauge injector system in an outpatient setting. To circumvent the risks associated with corticosteroids use, non-corticosteroids related therapeutics including intravitreal methotrexate; anti-vascular endothelial growth factor treatments and intravitreal sirolimus have been recently developed.
本文综述了有关非感染性葡萄膜炎眼内治疗的新的临床相关数据。曲安奈德是治疗葡萄膜炎和葡萄膜炎性黄斑水肿最常用的玻璃体内注射用皮质类固醇。该药物成本低廉,但与眼压升高和白内障的高风险相关,且未获眼内使用许可。地塞米松植入剂(Ozurdex®)似乎具有更好的安全性,且比曲安奈德的作用持续时间稍长。氟轻松醋酸酯植入剂(Retisert®)可在3年内持续恒定释放皮质类固醇,但需要手术植入,且其使用与白内障和眼压升高的非常高风险相关。Iluvien®是另一种氟轻松醋酸酯植入剂,未来可能成为此类病例更便利的治疗选择,因为它可在门诊通过25号注射系统插入玻璃体腔。为规避与使用皮质类固醇相关的风险,最近已开发出包括玻璃体内注射甲氨蝶呤、抗血管内皮生长因子治疗和玻璃体内注射西罗莫司等非皮质类固醇相关疗法。